School Nurse Procedure Manual - The School District of Philadelphia

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SCHOOL DISTRICT OF PHILADELPHIASCHOOL NURSE PROCEDURE MANUALSUBJECT: GENERAL PROCEDURES NUMBER 511.1CLASSIFICATION:CATEGORIES OF EMERGENCIES (DEC. 98)Students, teachers, other School District of Philadelphia employees, and visitors may have medicalemergencies at school or off school premises, but on school business (e.g., on the school bus, field trips,etc.). All personnel should be familiar with the School District of Philadelphia First Aid Chart ANDshould know how to access the Emergency Medical System (EMS) by calling 911.While most emergency situations encountered in schools are not life threatening, the possibility exists thatthey may be. It is appropriate to develop plans for immediate treatment and mobilization of emergencyservices. EACH SCHOOL SHOULD HAVE AN EMERGENCY PLAN IN PLACE. The CertifiedSchool Nurse should be involved in the development of the plan.The Following triage plan was developed for schools by the Connecticut American Academy of PediatricsSchool Health Committee. It is adapted and included here as a guide in the development of the SchoolEmergency Plan.Emergencies are divided into categories, depending upon the amount of time which is allowed to elapsebefore intervention is necessary to save lives or prevent death. School Emergency Plans should takethese categories into consideration.I. CATEGORY I Emergencies are Emergent or Life Threatening.A. In these situations:1. The first person on the scene should Call 911 immediately for transport to the nearestemergency room. No time should be wasted making contacts with the school nurse, families,or physicians until 911 has been called.2. Send for assistance and remain with victim.3. Administer any authorized medication at once, e.g. epi - pens or glucagon.4. Administer first-aid to the level of competence.5. Initiate CPR; if CPR certified staff is available.6. Once EMS takes over, notify parents/guardians.7. Notify principal or person in charge.8. Document all activities.9. File Incident Report.B. Examples of CATEGORY I Emergencies are:1. Acute airway obstruction2. Cardiac arrest ( no heartbeat)3. Respiratory arrest (not breathing)4. Drowning or near drowning5. Massive bleeding, internal or external6. Poisoning internal or external7. Anaphylaxis8. Neck or back injury (possible spinal cord injury)9. Chemical burns of the eye10. Heat stroke11. Penetrating (stab) or crushing chest wounds12. Severe acute asthma attackSeptember 1, 2002 Page 39
SCHOOL DISTRICT OF PHILADELPHIASCHOOL NURSE PROCEDURE MANUALII.CATEGORY II Emergencies are urgent.III.A. In these situations:1. Arrange for immediate transportation to the nearest hospital.2. Administer any authorized medication at once, e.g. asthma medication.3. Administer first-aid to the level of competence.4. Notify principal or person in charge.5. Document all activities.6. File Incident Report.B. Examples of CATEGORY II Emergencies are:1. Internal bleeding2. Angina or chest pain3. Unconscious states4. Heat cramps5. Major burns6. Drug overdose and reaction7. Head injury with loss of consciousness8. Penetration eye injuries9. Seizure in a person who is not known to have seizures10. Bee stings with rash but no breathing difficultiesCATEGORY III Emergencies: Medical consultation is desirable within an hour, although delayswill not seriously affect the outcome.A. In these situations staff can render care:1. In accordance with the School District First Aid Chart.2. Parents/guardians should be contacted to arrange further care by their primary care provider.3. All actions should be documented.B. Examples of CATEGORY III Emergencies are:1. Lacerations (cuts) that require sutures2. Animal and human bites3. Burns with blisters4. Tooth loss or fracture as a result of fracture5. Bone fractures and dislocations6. Acute emotional state7. Moderate reactions to medications8. Fever above 103 degrees9. Asthma/wheezing (Yellow Zone Peak Flow, if available)10. Non-penetrating eye injuryIV.CATEGORY IVA. Emergencies: In these instances some students will have care plans which were developed by theschool nurse. Otherwise:1. Staff can render care according to the School District First Aid Chart.2. Notify principal or person in charge.3. Document all activities.September 1, 2002 Page 40
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School Nurse Procedure Manual - The School District of Philadelphia

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